Differentiating physical discipline from abuse

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Grace Wing Ka Ho

A dissertation submitted to Johns Hopkins University in conformity with the

requirements for the degree of Doctor of Philosophy

Baltimore, Maryland

November 2014

© 2014 Grace W.K. Ho

All Rights Reserved


Background: Perceptions and use of physical discipline (PD) are grounded in culture. While the distinction between PD and child physical abuse (CPA) remains unclear, the subjective nuances between acceptable and unacceptable parent discipline behaviors may increase the risk of child abuse allegations for parents whose traditional parenting values endorse PD use. Although the reported rate of child maltreatment among Asian Americans is comparatively low, the rate of Chinese American parents reported for CPA is disproportionately high compared to the general population. It is imperative to understand how these minority parents differentiate PD from CPA, and how their differentiations compare with those of mandated reporters of child abuse.

Objectives: (1) To examine how Chinese American mothers differentiate PD from CPA, (2) to examine how pediatric nurses differentiate PD from CPA, (3) to describe how Chinese American mothers’ differentiation between PD and CPA differ from those of pediatric nurses, and (4) to describe how acculturation influences Chinese American mothers’ perceptions of PD and CPA.

Design and Methods: A cross sectional, descriptive study using Q-methodology was employed to generate holistic viewpoints of PD and CPA differentiation. The study was performed in two sequential phases: (1) semi-structure interviews were conducted to generate a list of statements related to the behavior or outcome of punishing a child, (2) participants sorted the statements on a predefined continuum ranging from “Most Unacceptable” to “Most Acceptable” to elicit their views on acceptable and unacceptable parent discipline behaviors. By-person factor analysis was used to generate groups of participants who performed similarly on their sorts. Acculturation levels of Chinese American mothers across groups were compared.

Sample: A convenience sample of Chinese American mothers were recruited and, stratified by generational status (i.e., foreign born or US born). Eleven Chinese American mothers participated in Phase 1, and 35 additional Chinese American mothers participated in Phase 2. Forty-eight pediatric nurses from one urban academic medical center with at least 2 years of pediatric nursing experience also participated in Phase 2 of the study.

Results: There was wide consensus on highly acceptable and highly unacceptable punishments across all viewpoints. However, there were important nuances in PD and CPA differentiations that stemmed from complex interactions among 5 contextual domains of PD (i.e. specific PD behavior, parent intention, PD outcome, PD delivery method, and pattern of PD use). Chinese American mothers’ and pediatric nurses’ views on PD versus CPA were equally diverse. Acculturation influenced the endorsement of PD among Chinese American mothers in this sample.

Conclusions: There was wide agreement on what discipline strategies constituted most acceptable and abusive parenting behaviors. However, the nuances in PD and CPA differentiations may create a potential for discrepant risks for child abuse allegations among Chinese American mothers and disparate tendencies to report child abuse among pediatric nurses. The relationships among the PD domains identified in this study warrant further investigation.
Advisor: Dr. Deborah A. Gross, DNSc, RN, FAAN

To my father, Albert.
Funding for this dissertation work was provided by:

A.T. Mary Blades Foundation Scholarship

Caylor Award

Johns Hopkins University School of Nursing Scholarships

Jonas Nurse Leaders Scholar Award

Sigma Theta Tau International/ American Nurses Foundation Grant

Sigma Theta Tau Nu Beta Chapter Nursing Research Award


Southern Nursing Research Society Dissertation Award


The views expressed in this document are those of the author, and do not necessarily represent the official views of the funders.


I owe my deepest gratitude to my advisor and mentor, Dr. Deborah Gross, who introduced me to the wonders and challenges of scientific research. I learned to become a critical, confident, and independent thinker through you, and I will always be grateful for your kindness, patience, and encouragements.

I would like to thank my committee members, Drs. Andrew Cherlin,

Marie Nolan, Anne Riley, Elizabeth Sloand, Hae-Ra Han, and Jennifer Wenzel, for supporting my work and for sharing their time, wisdom, and expertise with me.

I am indebted to the mothers and nurses who volunteered to participate in this study, and I would like to extend a special thanks to Dr. Mei-Ching Lee and the Baltimore-Xiamen Sister City Committee for assisting me with recruitment.

I sincerely appreciate the support, education, and opportunities that I received here at JHUSON; I am especially thankful for the guidance, insights, and generosity from Drs. Jeanne Alhusen, Jacquelyn Campbell, and Daniel Sheridan. To my friends here, especially Yvonne, I will always cherish the laughs, fellowship, and aha moments that we shared.

I would like to thank my family and friends in Hong Kong. Importantly, to my mother, Cindy, and my elder brother, Thomson, thank you for supporting my dreams and ambitions with love and enthusiasm. I hope I have made you proud.

Finally, I wish to thank my husband and best friend, James Park, who has shared every worry and joy with me along the way. I look forward to celebrating many more achievements with you.

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